Procedure codes 10060 and 10061 represent incision and drainage of an abscess involving the skin, subcutaneous and/or accessory structures. Therefore, the medical necessity diagnosis code must represent an abscess, not the underlying condition causing the abscess.
Before you code a superficial incision and drainage (I&D) of an abscess, it’s important to know whether the procedure is simple or complicated. During an I&D, the provider makes an incision over and into the abscess cavity and allows it to drain.
It may be left open allowing the continuation of drainage, loculations may be broken up using a surgical clamp, and/or the wound may be packed with gauze. Choose between two codes for I&D of a superficial skin abscess: 10060 Incision and drainage of abscess; simple of single. 10061 Incision and drainage of abscess; complicated or multiple.
For example, for an I&D of a deep abscess on the thigh refer to code 27301 Incision and drainage, deep abscess, bursa, or hematoma, thigh or knee region, or for an I&D of a vulva abscess refer to CPT® code 56405 Incision and drainage of vulva or perineal abscess.
This would be reported with ICD-10-PCS code 0J990ZZ (Drainage of buttock subcutaneous tissue and fascia, open approach).
For incision and drainage of a complex wound infection, use CPT 10180. You can remove the sutures/ staples from the wound or make an additional incision to work through. The wound is drained and any necrotic tissue is excised. The wound can be packed open for continuous drainage or closed with a latex drain.
CPT code 10080 is used for a simple incision and drainage with local wound care to facilitate healing. And CPT code 10081 for a complicated incision and drainage which includes placement of a drain or packing with gauze. For percutaneous aspiration of abscess, hematoma, bulla or cyst, procedure code 10160 is used.
No to both questions. CPT code 10060 includes incision and drainage, and you stated no incision was made. CPT code 10160 includes puncture and aspiration, and you stated no aspiration was made. The puncture as indicated in your scenario above would be part of the E/M service performed for the patient at that encounter.
For example, there is a considerable difference in reimbursement between CPT codes 10060 and 26010. According to the Medicare Physician Fee Schedule (MPFS), average reimbursement for code 10060 is $121.68, while the average reimbursement for code 26010 is $272.88.
Simple procedures would be reported with CPT 10060, Incision and drainage of abscess (eg, carbuncle, suppurative hidradenitis, cutaneous or subcutaneous abscess, cyst, furuncle, or paronychia); simple or single.
An incision (not just a puncture) is performed, and the abscess is left open to drain and heal. A complicated I&D 10061 would usually require one or more of the following: multiple incisions, probing to break up loculations, extensive packing, drain placements, and wound closure.
CPT codes 10080 and 10081 include incision and drainage of a pilonidal cyst. CPT 10080 is for a “simple” incision and drainage of a pilonidal cyst. CPT 10081 is for a “complicated” incision and drainage.
As specified in the code descriptors, use 10060 for single abscess, or for a small collection of purulent material (e.g., paronychia, or a small cyst around a hair follicle). For I&D of multiple abscesses, or of a single large or “complicated” abscess, turn to 10061.
In order for all three line items to be paid by Medicare, it should be coded in the following way: 10060 with DX L02. 611, no modifiers.
10061 – Incision and drainage of abscess (e.g., carbuncle, suppurative, hidradenitis, cutaneous or subcutaneous abscess, cyst, furuncle, or paronychia); complicated or multiple. The second code, 10061, is probably the best code to use for the procedure you describe.
You also need to know the location because if the abscess is deep, code choice is based on the location of the abscess and is not dependent simply on single versus multiple, and simple versus complicated. Appearance and signs and symptoms can assist with determining simple versus complex.
An incision must be performed and documented to bill for this procedure. If the provider uses a needle to puncture the abscess, and lets it drain, it is not appropriate to use the incision and drainage codes. This procedure would be included in the evaluation and management of the patient for the day and not separately reported.
CPT codes, descriptions and other data only are copyright 2021 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.
Title XVIII of the Social Security Act, Section 1833 (e) states that no payment shall be made to any provider of services or other person under this part unless there has been furnished such information as may be necessary in order to determine the amounts due such provider or other person under this part for the period with respect to which the amounts are being paid or for any prior period..
This Billing and Coding Article provides billing and coding guidance for Local Coverage Determination (LCD) L33909 Incision and Drainage of Abscess of Skin, Subcutaneous and Accessory Structures. Please refer to the LCD for reasonable and necessary requirements.
It is the provider’s responsibility to select codes carried out to the highest level of specificity and selected from the ICD-10-CM code book appropriate to the year in which the service is rendered for the claim (s) submitted.
All those not listed under the “ICD-10 Codes that Support Medical Necessity” section of this article.
Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type.
Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination.
The following crosswalk between ICD-10-PCS to ICD-9-PCS is based based on the General Equivalence Mappings (GEMS) information:
The ICD-10 Procedure Coding System (ICD-10-PCS) is a catalog of procedural codes used by medical professionals for hospital inpatient healthcare settings. The Centers for Medicare and Medicaid Services (CMS) maintain the catalog in the U.S. releasing yearly updates.